It seems like every other billboard and commercial in the U.S. is for a prescription drug. And yet consumers can't buy them without a doctor's approval. So why target consumers with these ads? Do we really have that much influence over physicians? Here's how the U.S. became one of the only countries in the world where pharmaceutical companies peddle drugs to ordinary people.

Food and Drug Administration Loopholes

The United States and New Zealand are the only countries in the world that allow direct-to-consumer advertising of pharmaceuticals. Most countries banned the practice in the 1940s. The direct-to-consumer market was pioneered not in a corporate boardroom, but by Joe Davis, a regular salesman who sold packaged goods.

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At the time, pharmaceutical companies marketed only to physicians through print mailings, visits, and free samples, with the patient knowing little about the drugs they were taking. The physician told them what to take, and they followed directions. About this era, Davis recalled:

Nobody had ever thought that these drugs should be or could be advertised to the patients. It was just outside of people's brain […] They thought that only doctors could understand the products. They're technical products. They're scientific products.

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But that's not what Davis thought.

Davis went to his friend William Castagnoli, an executive at the medical advertising company Medicus in the mid-1980s. Castagnoli was of a like mind, and the two devised a way to "pull the drug through the system" through direct-to-consumer marketing. The problem was that the FDA required any drug ad to include a full list of possible side-effects, which often took several pages of tiny print. Hard to do that in a TV spot.

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So the two devised a way to recommend drugs in ads that did not mention the name of the medication, but only the positive effects of a hypothetical drug with the exact attributes of a specific pharmaceutical. Commercials ended with instructions for the consumer to see their doctor for more information. By omitting the name of the drug, the two were able to slide their ads through a loophole in FDA regulations.

The unnamed drug they marketed was Seldane, which they tagged as an "antihistamine that did not cause drowsiness." When patients asked doctors for this exact type of drug, they got Seldane. Over the next few years, Seldane went from sales of $34 million a year in 1985, to $800 million per year. (Seldane, interestingly, was removed from the U.S. market in 1997 after it was found that the drug could cause heart arrhythmias.)

Yes, you influence your physician

Davis and Castagnoli succeeded in converting your physician from a caretaker to a business intermediary. Advertising to consumers puts physicians under a new kind of pressure. If they want to keep you as a patient, and if giving a prescription for a drug that you asked for keeps you happy, they might do it. Evidence backs this idea: advertising has raised the prescription rate of direct-to-consumer advertised drugs by over 30%. The prescriptions that patients ask for may be unnecessary (though harmless) and expensive, but the physician yields a bit of power to keep the patient happy.

The advertisements are a money maker

Most commercials are for new medications, in their first year on the retail market. Often, they cater to chronic conditions, and therefore these medications are not available in cheap, generic form. They also cater to patients who will be taking the medication for a long period.

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For every dollar spent on ads for drugs, over four dollars in retail sales are garnered. A May 2011 study showed that new drugs that feature direct-to-consumer advertising are prescribed nine times more than their new counterparts that lack consumer advertising. But what about those FDA regulations against pharma ads? Aren't the companies disobeying them in spirit, if not the letter? Pharmaceutical marketing firms often respond to this line of questioning by arguing that their ads are well within the realm of freedom of speech.

Banned commercials and the definition of pharma badvertising

The FDA does keep an eye trained on any type of direct-to-consumer marketing, whether it be via print, internet, or commercials. The FDA pulled a commercial for Straterra, an ADHD medication, after determining that the commercial confused the properties of the drug due to erratic movement and competing visuals, also obscuring disclosure of side effects. Google was recently fined half a billion dollars for direct-to-consumer advertising via its popular AdWords service, with the Department of Justice finding Google party to the illegal movement of pharmaceuticals from Canada into the United States through directed web advertising.

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Pharmaceutical commercials are often a bastion of strangeness as well, dominated by cartoons, unusual scenes, and just about anything that can be done to convey a general sense of wellness and direct you to your physician, salivating for pharmaceutical prompted by the ad. Some of my favorite examples of pharmaceutical badvertising are strewn throughout this article.

Take the red pill

The Nielsen Company determined that there are, on average, 80 drug commercials every hour of every day on television. Critics of pharma ads have suggested that no consumer marketing be made prior to physicians being fully informed about the drug and until the drug has been on the market for one year. But this idea, however reasonable, remains only a suggestion.

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I'd like to note that these commercials are not all bad. They may have positive impacts through breaking social stigmas against getting medical help — particularly with depression medications and Viagra. Still, as consumers, we need to be careful. Just because people are swinging happily or sitting side by side in a tub on a hill, doesn't mean you need the prescription being droned about in the background in a warm, monotone voice while the side effects of the drug scroll along the bottom of your screen.

Images courtesy of GlaxoSmithKline, Pfizer, and Sepracor. Sources linked within the article.